Q: Dr. Eppley, I had silicone 4.5mm Malar implants place 9 years ago. I have never been happy with the implant look after placement due to their large size but have been scared of the unpredictable result if they were removed. (i.e. facial sagging) Unfortunately I developed an infection due to a facial injury and need them removed. I am wondering if you could tell me if preforming a soft tissue suspension typically works in these circumstances and how long (days/weeks) does a soft tissue suspension takes to “set” per say. Also is there anything that can be worn on the outside of the face to help hold the tissie up while its healing ie tape or a surgical mask? Thank you for your time answering my questions.
A: Because a cheek implant (actually any implant in the body) creates a circumferential capsular lining which is very smooth and avascular, implant removal leaves two sides of the smooth capsule to collapse together. Because of the soft tissue expansion caused by the implant and the fact the cheek bone is like a rock ledge on the side of a cliff, removal of the implants has the definite potential for the outer cheek tissue to slide down off the cheekbone as the smooth surfaces of the capsule will not stick together, resulting in post-implant removal cheek sagging. Whether this is a significant risk for any cheek implant removal patient depends on numerous factors such as the size of the original implant, the prominence/angle of the cheekbone and the existing quality and looseness of the overlying cheek soft tissues.
To prevent or manage the risk of cheek sagging after implant removal, there are various strategies. One intraoral approach is to either suture the two sides of the implant capsule together with some permanent sutures (sliding the outer cheek tissue up as high on the bone as possible) or to replace the implant with the Endotine cheek lift device to provide uplifting support. Extraoral or external strategies can be done with either a transcutaneous lower eyelid approach to cheek soft tissue suspension or en endoscopic temporal or scalp approach to elevating the cheek tissues. Which approach is based would be based on the degree of cheek soft tissue sagging a patient has. If it is a pure preventative approach then use either of the intraoral technques. If cheek sagging is evident even with cheek implants in place, then an external approach would produce a better result with cheek implant removal.
Dr. Barry Eppley